bestBETs

A 60 year old female patient has treatment for widespread generalised OA. Her friend peruses the shopping channel and wants to buy a magnetic bracelet as a gift. Your patient wonders if this is a waste of money or may help her pain. You investigate further.

A 65 year old lady has had a total knee replacement for osteoarthritis. She has had an uneventful post op recovery and, as per protocol, has an appointment for outpatient physiotherapy. With the pressure on appointments you wonder whether a home exercise programme will be just as effective as outpatient programme at improving function and knee flexion range of movement.

A 31 year old male presents with a 3 month history lateral epicondylitis. You are planning to use standard treatments of electrotherapy, ICE, and exercises to improve his symptoms. You have heard from a colleague about an exercise regime based on eccentric muscle contractions and you wonder if there is any evidence of greater efficacy than the usual treatments.

A 29 year old male presents to AED with an acute ankle inversion injury sustained 3 hours previously. His ankle is swollen and he is capable though reluctant to take full weight. X-Rays reveal no bony injury. You want to encourage him to weight bear and decrease his pain and swelling so you decide to apply double Tubigrip™ bandage (DTG). But as supplies are getting very low, you wonder if there is just as much benefit from using single Tubigrip™ (STG) and decide to investigate further.

A 28 year old woman presents to the emergency department with a 4 hour history of right iliac fossa pain, and an examination suggestive of acute appendicitis. You are aware that an isolated blood count is neither specific nor sensitive in the diagnosis of appendicitis, and the on-call surgeon suggests that an ultrasound scan may be helpful.

You are seeing a patient in the A&E department with a fracture shaft of humerus.You have never applied a U-slab before and wonder if applying a brace instead would be detrimental to the healing of the fracture.

An 8 month old child presents to the Emergency Department in status epilepticus and is given so much benzodiazepines during treatment that he can no longer protect his airway. His vital signs are all stable and a non-rebreather mask is helping him to maintain his oxygen saturations. As you prepare to intubate him using RSI, you wonder if atropine is really necessary or helpful in preventing the bradycardia reported during endotracheal intubation.

A child presents with acute asthma. You start standard treatment with salbutamol, ipratropium and steroids. Your medical student points out that nebulised epinephrine is used for children with acute severe bronchiolitis, and wonders why you do not use the same treatment in asthma.

A thirty year-old lady with a history of depression is brought into the Resuscitation Room as a "Standby Call". She claims to have taken 50 of her amitriptyline tablets. Her ECG demonstrates ventricular tachycardia. You wonder whether magnesium sulphate will confer any advantage over stndard treatment (including correction of hypoxia and acidosis and bicarbonate infusion).

An eighteen year-old lady has ingested 20 of her 75mg amitriptyline tablets and presented to the Emergency Department. Her blood pressure is 80/40. You consult TOXBASE, which suggests administering intravenous fluids for the hypotension. You wonder if there is any evidence that intravenous fluids are helpful in this situation and whether there is any evidence that colloid is superior to crystalloid.

12 months old boy tried to walk and fell over. He was unable to weight bear. Examination revealed mild tenderness over the distal tibia and xrays of tibia and fibula showed no fracture. You wonder whether you should treat him in above knee plaster for presumed toddler's fracture.

A 65 year old man was admitted to the ICU department with ARDS secondary to acute pancreatitis. He was found to have a raised Troponin on random blood testing. It was considered whether the raised troponin was a poor prognostic indicator for the patient.

A 68 year old attends the department with knee pain. The knee appears swollen and he tells you he has Christmas disease. He has considerable pain and has been told by a relative that acupuncture is wonderful. You wonder whether it is a good or bad thing in this condition.

You are about to perform CABG and aortic valve replacement surgery on a 75-year-old man with a history of diabetes, hypertension, carotid disease and transient ischaemic attacks. Your colleague suggests that you should give your patient aprotinin to minimise the risk of cerebrovascular complications but given recent controversies you decide to review the literature to investigate what evidence there is to suggest aprotinin has neuroprotective properties.

You are reviewing a 55-year-old patient in the clinic who underwent coronary bypass grafts 6-weeks ago after he suffered a non-ST segment myocardial infarction (NSTEMI) the week before. You notice that the cardiologist saw him last week and restarted his clopidogrel in addition to the aspirin you gave him. The cardiologist wrote in his letter that he recommenced this on the basis of the 2004 ACCP guidelines. You resolve to investigate this further.

A 25 year old man presents to the emergency department with pharyngeal bleeding post tonsillectomy. You wonder whether haemostasis can be achieved by using nebulised adrenaline.

An 8-month-old girl has been referred to the emergency department by her general practitioner with a 24-h history of drooling, intermittent screaming and low-grade fever (maximum 38.2°C). She is refusing solids and her fluid intake has decreased. Her parents report that her nappies are drier than normal but her stools are looser. She has had some relief from oral paracetamol syrup. Her parents suspect teething. On examination she is found to be miserable. She is not clinically dehydrated and has a diffusely hyperaemic right cheek. On examination of her mouth you notice a raw area on her upper gums where two teeth are erupting. No other abnormal clinical signs are noted. You agree that the infant may be teething, but wonder if there are any symptoms that would distinguish between teething and an alternative diagnosis.

A 4-year-old girl presents with low-grade pyrexia and dysuria. A urine dipstick test shows positive results for leucocytes and nitrite, suggesting urinary tract infection. On examination, you notice partial adherence of the vulval labia minora. Her mother reports that the girl has intermittently had discomfort in the genital area over the last year. While waiting for the results of the urine microscopy, you remember that one of your colleagues has mentioned treating labial adhesions with oestrogen creams in the past. You wonder whether there is good evidence to support their use in this condition.

A 5-week-old infant is admitted to a high dependency unit with paroxysmal cough associated with dusky episodes. The severity and frequency of cough paroxysm increases and 48 h later pernasal swab confirms the diagnosis of pertusis. You want to treat the infant with erythromycin. However, you have heard that erythromycin can cause hypertrophic pyloric stenosis in young infants. So you decide to find out more before starting the treatment.

"A 35 year old male presents to the physiotherapy department two weeks after an acute episode of low back pain with referred leg pain. You make a clinical diagnosis of acute lumbar disc prolpase. Evidence based national guidelines suggest it is effacious to give advice on back care education & the stay active concept, but you want to add in manual therapy as you feel this will further speed up his improvement.You decide to see if there is any evidence to support this."